REPUBLIC OF THE PHILIPPINES)

CITY OF ..........................................)

AFFIDAVIT OF DESISTANCE

I, _____________________, of legal age, a resident of ______________________,

after having been duly sworn in accordance with law, hereby depose and say:

That I am the private complainant against accused __________________ for the

crime of ______________ before Regional Trial Court, Branch _______,
____________ City, Philippines, docketed as Criminal Case
No. ________________;

That after a careful re-evaluation and mature deliberation of the surrounding

circumstances which led to the filing of the said case, I am now fully convinced that
it was a result of pure misunderstanding of the incident that happened on
_________________ or misapprehension of facts, more importantly, when I am not
at the place of incident at the said time and date which is the subject matter of this
case;

That I am no longer interested in the prosecuting this criminal case and shall desist
in further testifying against accused ____________________;

That I most respectfully request the Provincial Prosecutor to please cause the
dismissal of the instant case against accused ________________________;

That I have fully read the foregoing statements and I attest the same are all true and
correct and that I executed this affidavit voluntarily and with my own volition and
that I certify that I have voluntarily executed this instrument with full understanding
and without threat and intimidation upon my person.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________

at _____________ City, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of _____________ at the

City of ________________, Philippines.

Provincial Prosecutor
REPUBLIC OF THE PHILIPPINES)
CITY OF ..........................................)

SALAYSAY NG PAG-UURONG NG HABLA

Ako, _________________________, nasa hustong gulang, Pilipino, naninirahan sa

________________________________, matapos manumpa nang naaayon sa batas
ay malaya at kusang loob na nagsasalaysay ng mga sumusunod:

Na ako ang naghahabla laban kay _____________________ sa salang

___________________ na kasalukuyang nakabinbin sa Regional Trial Court
Branch ______, __________ City, Philippines at nakatala bilang Criminal Case No.
______________;

Na matapos kong mapag-aralang mabuti at muling suriin ang nasabing usapin na

naging dahilan ng aking pagsasampa ng reklamong ito ay napagtanto ko na ang lahat
ay bunga lamang nang di pagkaunawa sa insidenteng naganap noong
_______________ o ang tinatawag na misapprehension of facts lalo na at wala
naman ako sa lugar na pinangyarihan ng insidente noong nasabing petsa at oras na
siayng paksa sa kasong ito;

Na hindi na ako interisado na ipagpatuloy pa ang kasong ito, ganun din ang pag-
testigo laban kay ___________________;

at hinihinling ko sa Kagalanggalang na Tagausig Panlalawigan na ipawalang bisa o

dismissin na ang kasong nabanngit laban dito kay ______________________;

Na aking nabasa ang lahat ng mga banggit at aking pinatutunayan na ang mga ito ay
tunay at wasto at aking isinagawa ang Salaysay na ito ng buong laya at kusang loob
at aking pinatutunayan na ito ay aking lubos na nauunawaan at walang sinuman ang
siyang nanakot at pumilit sa akin upang isagawa ito.

SA KATUNAYAN NG LAHAT, ako ay lumagda sa ibaba nito ngayong ika-______

ng ______________ dito sa Lungsod ng ___________, Philippines.

Nagsasalaysay

SINUMPAAN AT NILAGDAAN SA HARAP ko ngayong ika- ____ ng

___________ dito sa bayan ng __________________________.

Panlalawigang Tagausig